Basic Information
| Provider Information | |||||||||
| NPI: | 1073910378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEELY | ||||||||
| FirstName: | DARRYL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S FLOYD ST STE 407 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021837 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2014 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1116491 | KY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 28214626 | IN | N | Nursing Service Providers | Registered Nurse | 367500000X | 3009244 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.